Provider Demographics
NPI:1912933870
Name:MADONNA, JOHN T JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:MADONNA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1506 ALICE ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4531
Mailing Address - Country:US
Mailing Address - Phone:912-285-9994
Mailing Address - Fax:912-285-9595
Practice Address - Street 1:333 W CARTER AVE
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-1412
Practice Address - Country:US
Practice Address - Phone:912-632-8961
Practice Address - Fax:912-632-5000
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME97383207RC0000X
GA031981207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG37160Medicare UPIN
GA06BDJCFMedicare ID - Type UnspecifiedMEDICARE